AB0431 CANAKINUMAB AS FIRST-LINE BIOLOGICAL THERAPY IN STILL’S DISEASE AND DIFFERENCES BETWEEN THE SYSTEMIC AND THE CHRONIC-ARTICULAR COURSES: REAL-LIFE EXPERIENCE FROM THE INTERNATIONAL AIDA REGISTRY
Authors: A. Vitale, V. Caggiano, M. C. Maggio, G. Lopalco, G. Emmi, J. Sota, F. La Torre, P. Ruscitti, E. Bartoloni, G. Conti, C. Fabiani, I. Mattioli, C. Gaggiano, F. Cardinale, L. Dagna, C. Campochiaro, R. Giacomelli, A. Balistreri, K. Laskari, A. Tufan, G. Ragab, I. Almaghlouth, E. Więsik-Szewczyk, R. M. Pereira, B. Frediani, F. Iannone, P. Sfikakis, L. Cantarini
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Treatment with biotechnological anti-interleukin (IL)-1 agents is recommended in patients with Still's disease especially in cases refractory to glucocorticoids and conventional disease modifying anti-rheumatic drugs (cDMARDs), avoiding a long-term glucocorticoids exposure. In cases with refractory arthritis, IL-6 inhibitors have shown to be effective on articular inflammatory involvement. <h3>Objectives</h3> The objective of the present study is to evaluate any difference in the effectiveness of the IL-1β antagonist canakinumab prescribed as first-line biologic agent between the systemic and the chronic-articular Still's disease. <h3>Methods</h3> Data were drawn from the retrospective phase of the AutoInflammatory Disease Alliance (AIDA) international registry dedicated to Still's disease. Patients affected by Still's disease classified according to internationally accepted criteria (Yamaguchi criteria and/or Fautrel criteria) and treated with canakinumab as first-line biologic agent were enrolled. <h3>Results</h3> A total of 26 patients (17 females, 9 males; 18 patients developing Still's disease after the age of 16 years) were enrolled; 16 (61.5%) patients suffered from the systemic pattern of the disease; 10 (38.5%) patients suffered from the chronic-articular type. No differences were observed between the systemic and the chronic-articular Still's disease in the frequency of complete response, of flares after the start of canakinumab (<i>p</i>=0.701) and in the persistence in therapy (<i>p</i>=0.62). No statistical differences were observed between the two groups after 3 months, 12 months and at the last assessment in the decrease of: the systemic activity score (<i>p</i>=0.06, <i>p</i>=0.17, <i>p</i>=0.17, respectively); the disease activity score on 28 joints (<i>p</i>=0.54, <i>p</i>=0.77, <i>p</i>=0.98, respectively); the glucocorticoid dosage (<i>p</i>=0.15, <i>p</i>=0.50, and <i>p</i>=0.50, respectively); the use of concomitant disease modifying anti-rheumatic drugs (<i>p</i>=0.10, <i>p</i>=1.00, and <i>p</i>=1.00, respectively). No statistically significant differences were observed in the decrease of erythrocyte sedimentation rate (<i>p</i>=0.34), C reactive protein (<i>p</i>=0.48), and serum ferritin levels (<i>p</i>=0.34) after the start of canakinumab. <h3>Conclusion</h3> Canakinumab employed for Still's disease has been effective in controlling both clinical and laboratory manifestations disregarding the type of disease course when used as first-line biotechnological agent. These excellent results might have been further improved by the early start of IL-1 inhibition. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.